Provider Demographics
NPI:1164529392
Name:ALEKSANDR D PUGACH MD
Entity Type:Organization
Organization Name:ALEKSANDR D PUGACH MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEKDANDR
Authorized Official - Middle Name:D
Authorized Official - Last Name:PUGACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-562-5700
Mailing Address - Street 1:70 COURT ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-3521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:70 COURT ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-3521
Practice Address - Country:US
Practice Address - Phone:413-562-5700
Practice Address - Fax:413-562-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157618207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9700030Medicaid
MAM17519OtherBCBS